- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $162.18 / $346.74
| Facility | 26 | $117.49 | $162.18 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $1,148.15
| Professional | | $354.81 | $512.86 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $144.54 / $281.84
| Professional | 26 | $85.11 | $144.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $794.33
| Professional | TC | $257.04 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $478.63 / $776.25
| Professional | | $338.84 | $478.63 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $107.15 / $173.78
| Professional | 26 | $79.43 | $107.15 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $602.56
| Professional | TC | $257.04 | $363.08 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $512.86 / $2,951.21
| Professional | | $125.89 | $512.86 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $162.18
| Professional | 26 | $97.72 | $117.49 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $436.52 / $616.60
| Professional | TC | $363.08 | $436.52 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | 26 | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $741.31 / $1,318.26
| Professional | | $323.59 | $741.31 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $104.71 / $194.98
| Professional | 26 | $66.07 | $104.71 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $575.44 / $1,148.15
| Professional | TC | $245.47 | $575.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $407.38 / $537.03
| Professional | | $338.84 | $407.38 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $120.23
| Professional | 26 | $75.86 | $93.33 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $316.23 / $416.87
| Professional | TC | $257.04 | $316.23 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,412.54 / $1,445.44
| Professional | | $831.76 | $1,412.54 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $158.49 / $181.97
| Professional | 26 | $125.89 | $158.49 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $758.58
| Professional | | $588.84 | $588.84 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $588.84 / $1,819.70
| Professional | | $109.65 | $588.84 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $173.78
| Professional | 26 | $89.13 | $114.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $562.34 / $912.01
| Professional | TC | $302.00 | $562.34 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $602.56 / $1,445.44
| Professional | | $316.23 | $602.56 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $102.33 / $186.21
| Professional | 26 | $60.26 | $102.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $478.63 / $1,202.26
| Professional | TC | $239.88 | $478.63 | $1,202.26 |